I’ve written before about how important it is to know what prescription medications are being administered in nursing homes and long term rehab facilities. Many do not have good efficacy, may be dangerous, or may cause problems when mixed with other medications. A new study indicates it is now also important to find out what over the counter (OTC) medications are being given.

The study, reported in the Observer, showed a link between certain medications in the class called anticholinergics and cognitive impairment in the elderly. OTC medications in this class include Dimetapp, Dramamine, Benadryl, and Unisom. This class of medications also includes the prescription medications Toviaz, Paxil and Seroquel. In the study, people using these types of medicines exhibited reduced brain function and increased brain atrophy. Specifically, the study showed that use of these meds affected immediate memory recall and cognition, and may also induce cell death.

Continue Reading New Study Shows Common Medications Cause Cognitive Problems in Elderly

Often, elderly people are prescribed blood thinners, otherwise known as anti-coagulants, like Coumadin and several others. While these drugs can significantly help with conditions such as DVTs (deep vein thrombosis) and strokes, they also present unanticipated dangers. If you have a loved one who is on one of these medications, it is important to know the dangers that can occur with their regular use.

It shouldn’t be much of a surprise to learn that the number one issue safety issue for the elderly is the risk of falling. When the elderly fall, it can be very dangerous for two primary reasons. First, they can suffer bone fractures, most particularly to the hip. Hip fractures lead to immobility and many times death as a result. Second, if there is a head trauma, there can be internal bleeding in the brain. This is called either a subdural hematoma or epidural hematoma, depending on where the blood is pooling in the skull.

Continue Reading The Lurking Dangers of Blood Thinners in Nursing Homes

One of the most common illnesses I see in nursing homes is C-Diff – a bacteria that can cause severe dehydration or death.  C-Diff is most common in nursing homes and hospitals, and 80% of fatalities from C-Diff are in people over 65.  A recent article in the LA Times reports a recent study and gives the important statistics.

Anytime a person receives antibiotics C-Diff can become a problem.  C-Diff is resistant to most antibiotics (C-Diff is short for the Latin name Clostridium difficile – a Latin word meaning difficult, stubborn, or unreasonable).  We all have lots of bacteria in our gut, but when a person is on antibiotics the rest of the bacteria in the gut are killed, leaving the C-Diff as the only bacteria.  There is nothing to compete with the C-Diff and it proliferates.  Unfortunately, one of the side effects of the C-Diff breaking down food in the gut is toxic, and the body tries to rid itself of the poison with diarrhea.

If you have a loved one who just got antibiotics, be on the lookout for diarrhea.  Many times a person suffering from C-Diff will have diarrhea that is green or black, and it most likely has a very strong distinctive odor.

The most important thing is to be sure your resident is properly hydrated.  By knowing the symptoms of C-Diff you may save your loved one’s life.  We’ve had cases where un-trained staff miss these obvious symptoms, and in some cases even give people suffering from C-Diff anti-diarrhea medication so the toxins stay in the body, further poisoning a person.  Any diarrhea after antibiotics should be of concern. Stark & Stark’s Nursing Home Litigation Group has handled many cases of neglect and issues that arrise such as this, contact us today for a free consultation.

 

A recent series of disturbing stories by NPR report finding with objective data what many of us practitioners know already – that in many substandard facilities residents are over medicated with sometimes dangerous medications just to keep them quiet.  This is disturbing because these medications are sometimes powerful, dangerous, and ineffective.  Some even get “black box” warnings from the FDA.  It is a subject I’ve written about before and you can find the full article here.

The most recent NPR article points out that Texas ranks the highest in the United States for residents receiving anti-psychotic medications.  Interestingly, Texas also has caps on non-economic damages of $250,000 – i.e., no matter how negligent a company is and how much pain and suffering they cause, they are capped at $250K in non-economic damages.  Is this a coincidence?

With caps on damages, nursing home companies can more easily factor in lawsuits as a “cost of doing business” as opposed to spending more money to do right by people.  With no caps on damages, juries are free to award what they believe are just damages based on the facts.  The uncertainty of a jury verdict often forces companies to spend the money to do the right thing.  With caps, they know exactly what they’re facing.  It’s yet another reason caps do nothing but hurt people.

Knowing your resident’s medications and the side effects is important.  Don’t be afraid to ask about them in care conferences.

Many times I meet with families who were not told about medication changes or what a resident was prescribed.  It is easy to know what a resident is prescribed.  There is a document called a Medication Administration Record.  Nursing home staff refer to this document as a MAR.  It lists what a person is prescribed, what dosage, and when and how gave the medication.

This information is important to know for many reasons, one of which was recently highlighted in an excellent article in the LA Times.  A new study reported on in the LA Times showed the use of certain medications for anxiety and sleep increase risk of Alzheimer’s.   Unfortunately, the medications – the class called benzodiazepines that includes Xanax, Ativan, Valium, and Klonopin – are common prescribed in nursing homes.

The study indicated that those who took high doses for short periods of time, or lower doses, did not show problems.  It seems as though the problems are for those who took long-acting or high doses over several months.  You can read the full article here.

In one of the worst examples we have seen involving the abuse of the elderly, a company whose product was only approved to promote weight gain for HIV patients started to aggressively promote Megace to frail and elderly nursing home residents when the HIV population began to dwindle.  Knowing the dangerous side effects of this supplement (ie death), this represents a tragic example of profits over people.  To read more, click here.

A recent article details a new program launched by the Centers for Medicare and Medicaid Services (CMS) called the “Partnership to Improve Dementia Care in Nursing Homes” in order to address the problem of over medication of the elderly suffering from dementia in long term care.
 
The program seeks to reduce the use of antipsychotic drugs for nursing home residents by 15% by the end of this year.  A laudable goal given that a CMS study conducted in 2010 found that 17% of nursing home residents received daily anti-psychotic drugs exceeding recommended levels.
  
You can read the article here.
 

Ask any family member caring for an elderly parent with dementia about the number of medications prescribed and it’s likely to be quite a few.  It is important to know what someone is prescribed and what for.  A new study shows that roughly 20% of medications are prescribed “off label”. You can read an article discussing the study here.

“Off label” refers to prescribing medications for uses other than what the FDA has approved a drug for.  Despite what the FDA approves a specific drug to treat, doctors may prescribe drugs for anything – approved or not.  This practice is obviously not a problem per se, however, it might be more difficult for a consumer to learn about a drug’s pros and cons if it is being prescribed “off label”. 

It is important to discuss medications with a doctor.  Learn what risks, if any, a drug’s use entails. 
 

Despite the fact that antipsychotic drugs are approved by the FDA for specific uses, these drugs really may be prescribed for anything. When a drug is prescribed for something it is not approved or labeled for, this is called “off-label” use. 

Off-label use of anti-psychotics among the elderly is not uncommon. These medications are prescribed to residents who may suffer from Alzheimer’s or dementia, but who do not suffer from psychosis. This is concerning because several antipsychotics frequently prescribed “off-label” can have significant side effects for the elderly, including death. In fact, some of these drugs have received “black box” warning from the FDA – the most severe warning that can be given.

Always of concern to us is when medications are given solely for the convenience of the nursing home. In these cases, medications are given simply to make residents quiet and immobile. You see this in cases where staffing is cut to minimum levels and there are not enough people to adequately supervise the resident population.   

A new law has been proposed in an attempt to curb off-label use of powerful antipsychotics. The new law “will require the Health and Human Services Secretary to issue standardized protocols for obtaining informed consent, or authorization from patients or their designated health care agents or legal representatives, acknowledging possible risks and side effects associated with the antipsychotic, as well as alternative treatment options, before administering the drug for off-label use.” 

You can read the full article here, which includes a link to the amendment.